1. What are our Commissioning aims?
Minimise avoidable sight loss
Within the resources that we have available to us
Eye Health CPG as opposed to Ophthalmology CPG

2. How will we achieve this?
Radical, integrated service redesign
Develop new, more efficient models of care
Clinical programme approach
Driven by outcome data and audit
“ Be brave and go for it”
Part of the Sustainability and Transformation Plan (STP)

3. The Importance of Eye Health to a CCG
The most common surgical intervention performed by the NHS in England is age-related cataract extraction.
Hospital outpatient attendances for Ophthalmology account for the second highest number for any speciality. 6.8 million attendances in 2011/2012 (8.9%)
Eye health is one of the four clinical priorities for the RCGP between 2013/16
Planned Care – Predictable
Compare with unscheduled care

4. Anti VEGF Projection – 17,500 additional retinal clinic appointments by 2017

5. Financial and Operational Pressure
Spend on anti VEGF drugs in 2007/2008 was zero
It is now circa £3million

6. Five Year Forward View A Call to Action
Transformational change at scale and pace
Care closer to home where it is appropriate to do so
Breakdown the artificial barriers between Acute and Primary Care
Primary, secondary and specialist services working effectively together
Integrated care
Local solutions for local problems
Promote prevention and early detection of disease
2% net efficiency gains for the rest of the decade

7. Future Planning
“The NHS can no longer afford to operate in the way that it has been, and must act now to deliver substantial efficiency gains”
Dr. David Dennett, Chief Executive, Monitor
More of the same will not do.

8. The Commissioning Cycle

9. Clinical Programmes Approach
Using a standardise Clinical Programmes Approach to agree issues and solutions with clinicians:-
Service Walkthroughs with Service Users
Public Health Needs Assessment
Reviewed Evidence Base
Reviewed Finance and Data
Reviewed Patient Feedback
Documented ‘As is’ Process
Workshops to identify solutions and develop recommendations

10. All have a voice, all voices are equal
“Just to thank you for encouraging me throughout my time as the lay patient representative on the Eye Health Project, especially during the workshops
I have developed a great respect for all the other participants and learned a great deal from everyone. ”

11. Eye Health Workshops
Cataract
Glaucoma
Community
Medical Retina

12. Overall Issues Clinical outcomes Age of patients
Numerous rural patients
Secondary care capacity being stretched to the limit and beyond
Right patient, right place, right time, right clinician

14. Typical Co Morbidity Patient

15. Typical Scottish Co Morbidity Patient

16. Co Morbidities Obesity COPD Diabetes Hypertension CHD AF CVA CKD wAMD
Cataract
PVD
Chronic leg ulcers
Gout OA
Recurrent falls
BPH
Ca Lung
Dementia

17. Population Growth in Gloucestershire

18. Impact of population change on long term conditions

19. Rapid growth of diabetic population
2.9 million in 2011
5 million in 2025
400 new diabetics diagnosed every day
17 new diabetics diagnosed every hour

20. It’s behind you!

21. Eye Health Service Redesign in Gloucestershire
Children’s visual screening – paper based to electronic

22. Service redesign delivers results
Screening uptake has increased from 66.3% to 90% (opt in, now opt out)
False positives reduced from 31% to 18%
True positives increased from 5.1% to 12% (15% of children have problems with their vision that should be picked up by the screening test)
Audit shows that sight loss has been prevented in 50 children’s eyes per year compared to the previous screening system

23. Break down the artificial barriers between organisations (5YFV)
GCCG
GHNHSFT (Consultant Ophthalmologists, Optometrists, Orthoptists, Clinic Nurses)
GCS (School nurses)
Gloucestershire County Council (Public Health)
Gloucestershire LOC (Community Optometrists)

24. What this means for the Children of Gloucestershire
Avoidable sight loss has been prevented
Life choices have been enhanced
Pilot, Surgeon, Armed Forces, Firefighter

25. “You‘ve got to start with the customer experience and work back toward the technology - not the other way around."
Steve Jobs
May 1997, World Wide Developers Conference

26. Simon Stevens Quote
“think like a patient, act like a taxpayer”

27. Overall Ethos Right patient Right time Right place Right clinician
Right intervention
Right tariff

28. The Future Combined Authorities Pooled Sovereignty
Simplifies decision making and service redesign

29. What does success look like?
Maximal patient benefit for every pound spent on healthcare for patients in Gloucestershire
Joined up, patient centred approach